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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 44. -3 -3.4 BOX 18 02117 96 p 19 . 1 L. T ' T r % �N '. Lam-: Ll 1 02117 r PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S� ,_., r r T SYSTEM PCHD CONSTRUCTION PERMIT # Located at Town or Village pq r,22J AI Owner /Applicant Name �I N.4kiAl 6111&J&wgX- Tax Map 4� Block 0 Lot d. 4- Formerly . AMA Subdivision Name Z q Subd. Lot # 1- Mailing Address 6 7 04AeIZ16 e G1126" ( ' r"l-97U9,4 -r - � Ai Zip 1054/ Date Construction Permit Issued by PCHD ///00 Separate Sewerage System built by I-&-- I l4zZ Address 6:ua4f fVU 4j Rdl-�-o Arl7w-4� , i Consisting of I Z Gallon Septic Tank and S%U Y lyc ,tcfa2 A7°t cl,� a� a al is result for sodium. (Na) ,4 _ U _ a»�!I -• • _ Other Requirements: L11dil GU WP ',, /,•:.e x,:U Lill.! Jlevulu AIVL VG !e.7ldu 4V, sc- ium diets. Water containi more than 270 mg/L of -so be used by people on moderately Water Supply: PubliqJ%ipp{y jF qum diets. I.; , j. ' i'�►�A TY DEPT. OF HEALTH or: ✓ Private Supply Drilled by 1v1dA gN/�c�ry /n/�.,Address /SZ 6446t 9Z Cl-- Building 1,ype Y. a Has erosion control been completed? Number of Bedrooms X Has garbage grinder been installed?y I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations oft ty Department of Health. Date: �1- / Lo Certified b P.E. VR.A. (Design Professional) Address �U�h/'Ar�'1, �� 6G /�✓��b���� fir-. �� -l.G- License # 01' Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation,,, change is necessary. i M I By: Title: Date: Z a White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT WeII Location I/ StRet Addr ss: T /Villa e. �r Tax Grid # Map W Block Lot(s) , Well Owner: fqagW Address: 0—V of'' Use of Well: 1- primary 2- secondary �-- R identi 1 Public Su ply Air con at pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length 4,0 ft. Length below grade fig' Diameter li in. Weight per foot /lv lb /ft. Materials: ;-I- Steel Plastic _ Other Joints: _ Welded ?` Threaded _ Other Seal: x" Cement grout _ Bentonite Other Drive shoe: >4 Yes No Liner Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped X Compressed Air Hours 2 Yield gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve- analyses- - - are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation . . Description ft. ft. Land Surface g ®� _._ _ _.. _ ._ ._ _. _ _. � T .. — - - -- - - - • - - -- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) 1-4v,/jL r,: *xact location of welt wim aistances to at least two permaytent tTamarxs to be provtaea on a separate sheevplan. Well Driller's Name C,� � � c// Address -A ✓L - �� Y rte/ r /• Signature: Date: lax, White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES ' 32 et (914) 245-2800 Albert H. Padovani, Director LAB #: 93.003138 CLIENT #: 2905 NON STAT PROC PAGE 1 KING, ROY & DONNA 81 OAK RIDGE CIRCLE MAHOPAC, NY 10541 SAMPLING SITE: FAIR ST., PATTERSON, MAP : BLOCK 31 LOTS 3.4 COL'D B.: ROY KING NOTES ... : WATER TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTMAM CNTY PROFILE. 12/29/00 MFT. COLIFORM 12/29/00 LEA[) (IMS) 12/29/00 NITRATE N%TROG 12/29/00 NITRITE N%TROG 12/29/00 IRON (Fe) 12/29/00 MANGANESE (Mn) 12/29/00 SODIUM (Na) 12/29/00 pH 12/29/00 HARQNESS,TQTAL _ - 12/29/00. ALKALINITY (AS ----'- 12/29Y00 (TUR DATE/TIME TAKEN: 10/29/00 12:OOP DATE/TIME REC'D: 12/29/00 12:20P REPORT DATE: 01/16/01 PHONE: (914)-621-1824 44 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE�.: < 4C COLIFORM METH: MF -~~~~~~~~~~~~~~~~~-~~~~~~~~~~~~ RESULT ABSENT /100 ML 1.5 ppb 1"13 MG/L <O.01 MG/L 0.438 MG/L 0.032 MG/L 56.8 P4G/L 6.5 UNITS 272 MG/L 76.0 MG/L- NORMAL - RANGE METHOD ABSENT 1003 0-15 ppb 9101 W - to 9139 0/A 9146 , -0.3 mg/1 2037 0-0.3 mg/l 2037 N/A 6.5-8.5 9043 N/A , N/A ^ ' ()-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF �� SATISFACTORY SANITARY QUALITY ��CCOBI}Iy���� THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS,' FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p/ EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. ' No limits for Sod iu ' are proscribed. Suggested guidelines state that for people on sodium restricted diet,the water should contain no more than 20 mgyL of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES .321 Kear Street., (914) 245-2800 Albert H. Padovani, Director LAB #: 93.003138 CLIENT #: 2905 NON STAT PROC PAGE 2 --------- W_N --- N ---------------- ~ ----------- KING, ROY & DONNA 81 OAK RIDGE CIRCLE MAHOPAC, NY 10541 SAMPLING SITE: FAIR ST.v PATTERSON9 MAP : PLOCK 3, LOTS 3.4 COL'D BY: ROY KING NOTES...a WATER TANK — N N_m ------ m_N ---------- DATE FLAG PROCEDURE is suggested. DATE /TIME TAKEN: 10/29/00 12:OOP DATE /TIME REC'D: 12/29/00 12:20P REPORT DATE: 01/16/01 PHONE: (914)-621-1824 44 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ---------- RESULT . NORMAL - RANGE METHOD PH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES.--THE-NORMAL.RANGE OF pH IS 6.-5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN VIGIL. THE HARDNESS MAY RANGE FROM OJO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND.: .TREATMENT TO WHICH THE .WATER HAS BEEN SUBjEqTED.,-_- SOFT WATER _0'J_-'7 0 ... M_G_/* L _QEW MODERATELY HARD WATER: 70-140 VIGIL VIGIL = MILLIGRAM PER LITER HARD WATER: 140-300 VIGIL (I grain/gallon = 17.2 VIGIL) SUBMITTED BY: I/ I Alber'tw'*'H. Pad-o-vani, M.T (ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 1q11VA ILIA dot &12&1Z-s Owner or Purchaser of Building /ELI /Gl/t! K(_& r Building Constructed by Location - Street Building Type 4154 V &I Tax Map Block Lot TownNillage Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly. is caused by the willful. or. negligent.act of the occupant of the building utilizing the .:_ . _ ..r... - ..r............. _. _........ ._._..._ .� . _......._....._ .... The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated:.. Month q-1 Day Year 6) Signature: Contractor (Owner) - Signature Corporation Name (if corporation) Address: G 0)q71- /Lll16w C1,6z_-c_e' � Title: WM oAh WUNN® MAT19141ALA IJLK HOLLOW ROAD MAHORAC, NEW YORK 10541 (914) 528 -8110 Corporation Name (if corporation) Address: State Zip /01 State Zip Form GS -97 FEB -01 -01 05:06 PM TOWN OF PATTERSON 9148782019 02!01/200] 15:55 FAA 845 2798789 PUTNAM ENGINEERING BRUCE P. FOLEY Public Bealth Dirtetar P. 02 la 0021002 LORETTA MOLINARI R.N.. M.S.N. ,sagas Pub& Health Dlrrelor Dlrreter of Pattent Srnlas DEPAMEW OF HEALTH 1 Genova Road Brewster, Now York 10509 Enplronmesal Health (914) 978.6130 Fan (914) 276.7921 Nursing Services (914) 278.6558 WIC (914) 278 - 6673 Bat (914) 278.6015 Early Islemadon (914)271.5014 helchool (914)279.6082 Fm(914)278.6648 OWfiERS NAME: AA1A e11\1 TAX MAP NUMBER E911 ADDRESS: �/ W '7— T0WX.- r AUTHO=ED TOWN OFFICIAL: (Signature) DATE: �/— q Z r • The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form b; to be submitted with the application for a Certificate of Construction Compliance. ($911 VRPjW E L 'jNAM . P NEE_, PLLE ineers -and Architects SEPTIC SUBMISSION FORM TO: /&6ez' -r /`-& /1 DATE: PUTNAM COUNTY HEALTH 6EPARTMENT PROJECT: 6f%�%�II�I��` �t✓� S, ENCLOSED, PLEASE FIND: �J COPIES OF THE SSDS PLANc�L`�'� 0 2 COPIES OF THE HOUSE PLANS CONSTRUCTION ON C jyy��� ■ ■ ■ ■ ■ WELL P N HEALTH DEPARTMENT FEE_($ vim' SHORT EAF DESIGN DATA FORM LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) LETTER OF EXPLAINATION REMARKS: AZ -50 (3- ) , G1,9�n 471,44f- Vd l COPIES TO: SIGNED: 4 Oro RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 • EMAIL: puteng @bestweb.net F` PUTNAM COUNTY DEPARTMENT OF HEALTH M1 DMSION OF ENVIRONMENTAL HEALTH SERVICES o� FINAL SITE INSPECTION Inspecte : 4 , F,!e�E n Street Location '57-, Owner Hln Town 7=of7 -F�s�ir/ Permit # P-10 -9-b TM 9 - 3 - Subdivision Lot #-5l "��n,aritC 1. Sewage System Area a. STS area located as per approved plans ::.:' .....................:. b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area .......... e. 100' from water course / wetlands ...:.. ................................. II. Se%a a System T Septic tank size - 1,000 ...... ..1,2 ........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested............ 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set.. : ....................................... f. Trenches T.-I-e-niffi requiied 5`7 / Length installed 5' 70 2. Distance to watercourse measured r /1670 Ft.......... 3. Installed according to plan ......... ............................... i� 5. 10 Slope . from ep property line acceptable - 20 ft.- foundations.......... 161 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... Size of gravel 3/4 - lY2' diameter clean .................... .- Depth-of gravel ni trerich -12" miriiiha ::::::::.: :.:... ^ 10. Pipe ends capped ................................... :.................... g. PumR or Dosed Systems To 1. ir5tr� Size of pump chamber ............. ............................... . 2. Overflow tank ............................ ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade. ................ 5. First box baffled ........................................ :: ......... ::..... , . 6. Cycle witnessed by H.D.estimated flow /cycle........... III. H use/Buildin a .House located per approved plans. ...................... b. Number of bedrooms ................. ...3........................... . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured +too ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box........ i ........................ d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area............ h. Surface water protection adequate .... .........................E COMMENTS occc�'ovj w BRUCE R.._FOLEY w_ Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA . MOLIN_ ARI R.N., 1VVI.S.N Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: // 12z:9 Fax #: 17 7 — 6 7 6 % No. Pages .'2 (Including cover sheet) From: Gene D. Reed Putnam County Department of Health or your information Pleasearespolrtd" " ' ' .. For your review Attached as requested As discussed Please call - - - - -Notes/Messages vZ� , ^196125 % t� -72V-57,41-1— JZv 72 ZZ�QAI 5F1,196-LI -5X5 777; -J In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. FROM PVTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Nov. 16 2000 04:23PM P1 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES ffi.Ts IM *'WXKtUJ UMMW 20100-0)11 For: Fill Trenches PCHD Construction Permit # e 6 _- / —, Located /5121 l4 (MYL.- owncdAppljcant Name _46Z/� Formerly__g kL)Ue,(•-J /g Subdivision Name I-A t4a)Z11— Subdivision Let # Is system fill completed? I-J14 Date Is system complete - —, Z Date 11h7l rte? Is system constricted as per plans? Zgar f- 0 Is well drilled? - VA---T Date Is well located as per plans? Are erosion control measures ir, Place? I cmjW that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. 'Date":. I - Certified by-., - °.g :. r'..._ ._ . . --'Design Aafessioa Address .4* SACxfrrrA— Lic. # Comments: 1,"/ "-7— IzAf)%,VW- L-API-) Kd(;< AIZ6 &e)/A/6- 7-b 771C J-1 T&— AjLz C47J A4'47'-Gs svlge- 'C- r FOR-' ❑ ADAM ) GENE Form FIR-99 ;J • 'O. BRACE R, .FO)EY - _. _ _... __ .. _ _ _ _`� . - - ORETTA`� 1v10LINARI 'R , Public Health Director �' Q�� Associate Public Health Director — w Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York. 10509 Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 FAX C0111 SHEET Date: 'Lo t To:�id Fax #• 2.7 _ 76 2 In the event of transmission /reception difficulties- please.contact this office at (914) 278 -6130 ext. 2261. - a 'NAM COUNTY DEPARTMENT OF HEALTH ON OF ENVIRONMENTAL HEALTH SERVICES _ ..u.. -- CONS- T- RUeT>ZONV IVFGR� "AGE TREATMEiN SYS' E PERMIT # coo � , Located at /�����%� Town or Village �7�� 10AJ Subdivision name L,4 ~U''� Subd. Lot # Tax Map Block 3 Lot 4- Date Subdivision Approved �, --I q - ?/ Renewal Revision l/ Owner /Applicant Name X(JV OAI�,- - 1Gl 1JJ 1449t52& Date of Previous Approval fo Ig Mailing Address A01Z /Zi" CIZC -6- A o0,'4G e:�j J Zip Amount of Fee Enclosed J,57,0, 6-1) Building Type 945 Lot Area No. of Bedrooms --4-- Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12-50 gallon septic tank and 6-13 Z- � O F 04 Y ct-f/ 6f- 4 6SdrLP i? 4•J �c1Lfi- Other Requirements: /Cym to 1977-;V-70^% To be constructed by -7y &5- D &-7&7Zet4 r/L--0 Address Water Supply: Public Supply From Address - or: _ Private - Su pl Drilled by_' ���'''' _ �Ad�dress .�� _.. _. _ _ _.. �? _X .._ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. ----� Signed: P.E. E /.. R.A. _ Date (1 Address License # M % q!�L APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe proved f ischarge of domestic sanitary sewage only. By: Title: �� Date: l White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 , 34 - I 1. , �,� . ..�a ... % . - I . -- . -,, " � ,,- 1. _ , �,, �,,, ;.,__, ' - mi, � �pjj , " � -W-�p ."- wn� " , , - � '. s �'. :` _- - " - , --� ., � � , ,.,T � .: '. , - ", , - R, : ., � . . I . ; , - .. , .. I . " , - - - . 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I " of'% , Po - - I , _,�69pf' WiSi'ti _,Nkw��b� -, `A -� " . - NIP -E . - - - - � ;_ , I 1 & OLD -Rpt�T_�- 0-, � "J. , _� �,0609 ,,, 4 1, 79 , -11�_ 7, 1. _: W Mp - - - "�_..-�p�� � ,-, - "- � � -, - - . , , ., ,!. . , ."��10�,'eb.,he:,�', ,.---_ , -, � to � 4 -- , � :t,�, �- -.. . � r: .1 lot fql5k?�,T? - , - . , . . t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at S � - *IAWAJ 1ja1&4e72S T/V Tax Map 9 -'-IV Block 3 Lot Subdivision of Z-41n f Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Profiessional Engineer __/or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above-noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the P ' utnam County Health Department, and to sign all necessary papers on my behalf in connection with.this .- m't - "-'- - - * � - " - 4- " � . at er�and to -supervise -the-do'hstruction- of s�i&-wastewatertreaftnerit"and/or-water-sdli�ty-sygtem7g,- in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: Signed: P.E., R.A., # Prop em 67 q (Owner of P e ) Mailing Address Mailing Address: "4W &vol� i6�� State zip Telephone: C) State Zip/0 Telephone: ag NGOULDS Pu M PS COMPONENTS Item No. Description Volts' Phase 2 Casing 3 Silicon carbide vs. silicon carbide Mechanical seal 4 Shaft 5 Motor 6 All Ball bearing heavy duty design 7 Power cable 8 0 -ring MODELS 7 5 8 .. 1 2 Order No. HP Volts' Phase Max. Amp. RPM Solids Wt. lbs. Heaters WE0311 L WE0318L WE0312L /' 115 1 9.8 1750 , ._. _� 56 N/A 200 5.5 230 4.9 WE03 11 M WE0318M WE0312M 115 9.8 200 5.5 230 4.9 WE0511H WE0518H WE0512H Y2 115 14.5 3500 - - - 1 1 60 200 8.1 230 7.3 WE0538H 200 3 4.1 K34 WE0532H WE0534H WE0511HH WE0518HH WE0512HH WE0538HH WE0532HH WE0534HH 230 3.3 K32 460 1.7 K23 115 1 14.5 N/A 200 8.1 230 7.3 200 3 4.1 K34 230 3.6 K33 460 1.8 K23 WE0718H WE0712H 1 3/4 -200. 1 11.0 70 - ° _...... N/A 230 10.0 WE0738H 200 3 6.2 K49 WE0732H WE0734H 230 5.4 K39 460 2.7 K28 WE1018H WE1012H 1 _ .. 200 1 14.0 N/A 230 12.5 E1038H WE1032H, 200 _ 3 8.1 K50 230 7.0 K43 E1lT�4H' . -4b 5' - K32.. WE1518H WE1512H W 1538H WE1532H WE1534H WE151 HHH WE1512HH WE1538HH WE1532HH WE1534HH , 1 �2 200 1 17.5 50 95 230 15.7 80 N/A 200 3 10.6 35 K54 230 9.2 74 K52 460 4.6 - K36 200 1 17.5 77 N/A 230 15.7 WA 200 3 10.6 17 K54 230 9.2 66 K52 460 4.6 - K36 WE2012H WE2038H WE2032H 2 1 230 1 1 18.0 83 1 97 N/A 200 3 1 1 12.0 - K55 230 11.6 - K55 WE2034H 1 460 5.8 1 - K41 EFFLUENT EJECTOR SYSTEM Effluent ejector system offers ease of ordering and installation. A single _ ordering number specifies a complete system designed for most residential and I commercial sump and effluent pump applications. Package Includes: Submersible Eff luent Pump WE0311 L, 12L.or WE0311M,12M, WE051 1 HH, 12HH Mechanical Level Control Switch A2 -5 (115V), A2-6 (230V) Basin and Cover A7 -1830P Check Valve A9 -2P Order No.: SWE0311 L, SWE0312L, SWE0311M, SWE0312M, SWE0511HH, SWE0512HH. 6 4 3 PERFORMANCE RATINGS (gallons per minute) Order No. WE03L WE03M WE05H WE07H WE10H WE15H WE05HH WE15HH WE20H HP �/3 Y3 �/2 % 1 1 Y2 I '/2 1'/2 2 RPM 1750 1750 3500 3500 3500 3500 3500 3500 3500 5 86 - - - - - - - - 10 70 65 78 94 - - 56 95 140 15 58 58 70 90 103 128 53 93 138 20 30 35 60 85 98 123 50 90 136 25 5 15 48 76 94 117 45 87 133 30 - - 35 67 88 111 40 84 130 3 35 - - 23 57 82 103 35 82 126 40 - - 12 45 74 95 30 77 121 45 - - - 35 64 86 25 74 116 U. 50 - - - 25 53 77 18 70 110 55 - - - 17 42 67 12 66 104 60 - - - 9 30 56 3 63 97 65 - - - - 20 46 - 58 90 70 - - - - 11 35 - 55 83 75 - - - - 4 25 - 51 75 80 - - - - - 15 - 47 66 - 37 51 100 - - - - - - - 28 30 �120 - - - - 17 10- DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) KICK -BACK SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. Goulds Pumps N w ITT Industries Y:` [qGOULDS PUMPS Submersible Effluent Pump 3885 -- PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase: Specifically designed for the stainless steel. Threaded • Built -in overload with following uses: design. Locknut on three automatic reset. • Homes phase models to guard • All single phase models • Farms against component damage feature capacitor start • Trailer courts on accidental reverse rotation. motors for maximum • Motels ■ Fasteners: 300 series starting torque. • Schools stainless steel. •'/3 and' /2 HP —16/3 SJTOW • Hospitals ■ Capable of running dry with 115 V or 230 V three prong plug. • Industry without damage to • % -2 HP —14/3 STOW with • Effluent systems components. bare leads. ■ Designed for continuous Three phase: SPECIFICATIONS operation when fully • Overload protection must Pump submerged. be provided in starter unit. • Solids handling capabilities: •'/2 -2 HP —14/4 STOW with 3/4' maximum. MOTORS bare leads. • Discharge size: 2" NPT. ■ Fully submerged in high- ■ Designed for Continuous Operation: Pump ratings are • Capacities: up to 140 GPM. • Total heads: up to 128 feet grade turbine oil for lubrica- tion and efficient heat within the motor manufacturer'E TDH. transfer. recommended working limits, - Terug9ture: can be operated continuously ___.__2 104 °F (40 °Cj continuous- —` - - -® Class-B insulation:. -- .-==- v�i#kiout damage: -� -- - •� = -• . 140 °F (60 °C) intermittent. • See order numbers on reverse side for specific HP, METROS FEET voltage, phase and RPM's 130wEtSHr+ ..._I_..;....i.. °^ . °; .....;- - ..t -. .. available. �� 120 "� :..:.L..:..- _�..._..... _........._� --- FEATURES ■ Impeller: Cast iron, semi- W open, non -clog with pump - out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as o an option. ■ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge. ■ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA -N elastomers. ©1999 Goulds Pumps Fffertive January. 1999 110 30 100 90 25 80 70 20 60 15 50 40 10 30 5 20 10 ■ Bearings: Upper and lower heavy duty ball bearing construction. 6 Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. 20 foot standard with optional lengths available. ■ 0 -ring: Assures positive sealing against contaminants and oil leakage. ■ Consult factory for infor- mation on CSA listed models. AGENCY LISTINGS Canadian Standards Association SP- File #LR38549 _ 5`,� 9 Underw f le #8318 Laboratories Goulds Pumps is ISO 9001 Registered. —0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160GPM 10 15 20 25 30 35 m3/h CAPACITY Goulds Pumps <& ITT Industries LJT ` A V/ rlL l El NEERlNE, PLC C : n' a..?- w. w .��e:r�r�..:.xa'.T'.r>�P.:�fr.F :�.�.r �•�. �.Y Vna v.a ♦ r[,ru r..Y. ..v aw ... r.�..1 /a-♦ • .• •. .••• •••••• �..,i �.a :.a s re. ��n, rra r..�..+...�.�wm .. . ..:' w '. r.. •• = 'wa.,,�v.u•,.u. a. s + w w... an�� �. - xms�.�craR.:tzaraC... a.. � • �. - �nglneers and 4�chJtects FAIR STREET DUE TO THE ELEVATION IN THE SEWAGE DISPOSAL AREA, WHICH IS HIGHER THAN THE PROPOSED FACILITIES, A SEWAGE PUMP PIT WILL BE REQUIRED. FOR DOSING PURPOSES, IT HAS BEEN DETERMINED THAT A DOSE OF 75% OF THE VOLUME OF THE 4" PVC PIPE IN THE PRIMARY ABSORPTION SYSTEM BE UTILIZED. THEREFORE: 570 LF X (3.14) (0.167)2 X 0.75 X 7.48 GAL /CF = 279 GALLONS /DOSE pumP. ......._ 1. Q = 279 GALIDOSE = 27.9 GPM, USE 28 GPM 10 MIN /DOSE ONEK-Mm li _ • ELEVATION DISTRIBUTION BOX 550.0 ELEVATION PUMP PIT 537.0 13.0 3. FRICTION LOSSES Q = 28 GPM 2" DIAMETER PVC PIPE HEAD LOSS IN FT /100' OF PIPE = 1.8 HEAD LOSS FROM VALVES AND FITTINGS IN FT OF PIPE = 24' Q 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 0 (845) 279 -6789 o FAX (845) 279 -6769 . EMAIL: puteng @bestweb.net 4. DYNAMIC LOSSES 1.8X(70 +M= 1.5,USE 2' 100 TOTAL DYNAMIC HEAD = 13'+ 2'= 15' CHOOSE GOULDS SUBMERSIBLE EFFLUENT PUMP MODEL 3885 SERIES WE0311L 28 GPM @ TDH = 15 1:111D _' L.:_.11 M-1_ A 9' -6" X 4' -6" X 4' -3" (INTERIOR DIMENSIONS) 1,250 GALLON PRECAST SEPTIC TANK SHALL BE USED WHICH WILL PROVIDE STORAGE ABOVE THE HIGH LEVEL ALARM. A DEPTH OF 0.86' WILL PROVIDE THE DOSE VOLUME. THE PUMP OPERATING ELEVATIONS ARE TO BE AS FOLLOWS: BOTTOM OF PUMP PIT EL 537.00 PUMP OFF EL 537.25 - PUMP=ON EL 538.12- _.� . _ .. _ .._ d _. HIGH LEVEL ALARM �EL 538.50 2" PVC FORCEMAIN INV. OUT EL 541.00 4" PVC INLET IN EL 541.25 (File FM0087) PLITNAM ENGINEERING. PLLC. Engineers and Archltects 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 - Fax (845) 279 -6769 - EMAIL: puteng @bestweb.net PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a _.. Wii1Si'RUC T"IO — PERMIT FO .. AGE TREATMtNV STEW _. n PERMIT # 10-16 Located at�1�� Town or Village Subdivision name i--A M © R E Subd. Lot # A- Tax Map +41 Block *? Lot—',q-4 Date Subdivision Approved I - 9A ' 611 Renewal X Revision Owner /Applicant Name AH 1'k1A H C_0F`P- Date of Previous Approval Mailing Address &1 0,,&--V- P'1 D (LF, �-q Amount of Fee Enclosed Building Typed I CYHl'-�_ a 10 1 lB Zip � y� Lot Area W5V"') --No. of Bedrooms + Design Flow GPD b. Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: To be constructed by T °b _ ® i Water Supply: Public Supply From � 1�6 gallon septic tank and 4,6 Q j-f- A �' fA Address Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sdnarate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion tllereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. „ Signed: P.E. X R.A. Date ' a Address 1jli CltcvMIZNAI� P5Pe0`:)TV -1-V)i License# '�OG04 [°sue APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe , pproyed discharge of domestic sanitary sewage only. By: Title: ��r �(/�! %L Date: /�Ojo White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 J PUTNAM COUNTY DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES __._. APPLICATION TOy CONSTRUCT A WATER WELL please print or type rx ^� PCHD4Permit # Well Location: Street Address: Town/Village Tax Grr�id�I# 1'- Q - 5fP -EEC f o AT-f EPA H Map 44 % � r5 Block Lot(s) 4 Well Owner: Name: Address: N P"i4N GSM)' ?I O tk L- �L► D (4r Gi g fANt\QPK.� W% �o5°1i Use of Well: �_ Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 05 a' gpm # People Served 16- 6 Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 'A Is well located in a realty subdivision? ................................:..... ............................... Yes it No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: M t Town/Village N Distance to property from nearest water main: Proposed well well location & sources of contamination to be provided on separa sheet /plan. Rate. " Q� -- _ Applicant Signature: = - . -- V - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a at "ell driller certified by Putnam County. Date of Issue /U00 I Permit IM in is}aW Date of Expiration Z Title: d Y ✓ /` I.4 Permit is Non- Transf ra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Department of L-;mwrFnvj_ronlnental Protection OPERATIONS 4- ENGINEERING 45S C 0Z ll&&ZIS A VE,#VIIF sillrE Of Cover PWIVALLA, NFWYORX yos.9S JcAx 0343 Sheet Transmit toFAX#- Number of pages: Date'. E (Including Cover Sheet) PeliverTo: From: Phone:. subrJect CTI> L 6 rs IF THERE ARE ANY PROBLEMS REGARDING THIS FAX PLEASE CALL 914- June 27, 2000 Robert Morris, P.E. Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re; Lamorte Subdivision Lot #4 SSTS (T) Patterson; Fair. Street Middle Branch Reservoir DEP Log #7569 (Joint Review) Dear Mr. Morris: This letter is to inform you that the New York City Department of Environmental Protection (Department) has no objection to the approval of the above-referenced regulated activity. This determination is based On the review of submitted documents including the plan titled "Proposed SSDS, Lot 4," dated 06/29/98, last revised on 06/12/00. The applicant must contact Matthew Gannetta of my staff at (914) 742-2028 at least two days Prior to the start of construction of the SSTS so that the Department may inspect and monitor the installation. Sincerely,,. Margaret Lloyd, Supervisor Engineering Design Review xc* James Covey, P.E., NYSDOH PUTNAM COUNTY DEPARTMENT OF HEALTH La-f" DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - ° °= DESIGN DATA SHEET = _SUBSURFACE_ SEWAGE TREATMENT MTEIVI� Owner \/I]rD Address 1 UL-1�yUyLli•1G� ic`( Located at (Street)�� Tax Map 4-', Block 3 Lot 3. 9- (indicate nearest cross street) Municipality Drainage Basin CFA � SOIL PERCOLATION TEST DATA Date of Pre - soaking .5 .1 ::go Date of Percolation Test 0- 1 -11d. Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 1 1 1 _C� 2 5 I 2 I 3 1 1 - 2' 23 2 2 4. 2: i- 2 2 2 2 2 8 5 2 3 2'.o,2 - T, 2-7 a9 2 2 2 4- Y 5 1 2 3 4 .5 NOTES: 1. Tests to be.repeated at same depth until approximately equal percolation rates are obtained at eacn percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES : '• rise.: > --4 s... +Ti':�- C�_.r_zv'. "t+r:+. _. � a...�n. =m r .... .�..r-s: .:. .e:.. <s - ...rte. .a.��n ram.c+as:�cw...cc ..K•eF r w� DEPTH HOLE NO: I HOLE NO. 2 HOLE NO. G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 55 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered ' (,'_ D ' Indicate level at which mottling is observed Indicate.level to which water level rises after being encountered Deep hole observations made by: , K ��_ ��('C�„� nor Date Design Professional Name: Address: aD M ILL;DVj M g Al2 T SUj T(i 115 Signature: Design Professional's Seal Harry W. Nichols Jr., P.E 311 Clock Tower Commons :. . , ...� Route 22 - Brewster, NY 10509 Telephone (914) 2794003 Fax (914) 279 -4567 June 13, 2000 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATT: Robert Morris, P.E. RE: Individual SSDS- Renewal Lamorte Subdivision - Lot #4 Fair Street Town of Patterson - T.M. # 44. -3 -3.4 Dear Robert: Enclosed are the following: 1. Five (5) prints of drawing SS -4, "proposed SSDS," dated 6- 12 -00. 2. "Construction Permit for Sewage Disposal System," dated 6- 12 -00. 3. Well Permit Application, dated 6- 12 -00. 4. Letter of Authorization and Corporate Resolution dated 6 -7 -00. - -- -- -•- We >would. appreciate. y_our review, approval and issuance of-tlie.Construction Permit at your earliest convenience. Very truly yours, - - Harry . Nicho Jr., P.E. HWN:his 00- 124.00 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. -�. .. _ •.._: _..___,_.: n•: �.- a.-.r... •mow.._ a �. �..Ya:. us c :u.::•� . r.. - :: � - •:�• -: .__•v- �- :.a..- �- ....._ .. _..,.: ....:. s _... ..._.._il-n.: -r....�.K:,..ww..•c _. ..max m u .c:: <.r. cr..,?F.ve, � .. �. ...x-..._.�w�o-: m.. y -.. LETTER OF AUTHORIZATION RE: Property of ANAV4 N GO P-P Located at PAM.. OK T/V PAMA -60N Tax Map # 44 Block ') Lot '?- Subdivision of A IrQ I-W OWE Subdivision Lot # 4 Filed Map # 7-61'1 Date Filed 91 I-ObI9 1 Gentlemen: This letter is to authorize 1+"Y W% W1* G A0 L,.e> m J p- - PE a duly licensed Professional Engineer )C or Registered Architect - to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with:the_provi5 ons'_of Article 145- and/or •1-47 of the Education Law, the Public.Health - Law, and the Putnam Count)L t= Lary Code. Countersigned: P.E., R.A., # Mailing Address 1611 6$-EWSrrE p_ State NY Zip 1060 Telephone: 0"7 @ T-11 - 4 60 Very truly yours, Signed: (Owner of roperty) `pMS� J Nl ling Address: �I IZO� PH& State Zip Telephone: �q s., 6 L1 " I $10 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: 11401'14 1 P'Jt4- 15'" APPP-WA), - WnL APO KE SOJB-LW4 &MV0A A14AV4-0-6-10 represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: Whose Officers Are: President - Name: Address: t, Vice President - Name: 94-twy-,-, �4&,en r 1 + Address: Secretary -Name: Address:.--.'-- Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto;,,, SWW to before me this day of �-�(month 0 (year) Notary Public NoWy pub"O Sbft Of Now York, -flog No. 4980200 Qualified in Dutchess County �-Comrnisslon Expires 04/16/02 Form CA-97 Signed: Title: Corporate Se ,, 11 C7-)� " PUTNAM COUNTX DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR LLDROOD•1 COUNT ONLY, BEDROOMS ALL gEQUEP'IT I:.BV�S 0 j A1.T 3 AT'Oi�G TQ':TfI "HOUSE �L LUST PCDOI3 FOR A P VAI. BATE *IGNATURE & TITLE `` {�,t ►; �F. �r� �Z t' rr ' H� •� �• t ' .y,�. - t + -`'jfil rr.. J rt din _ - Fa y,.� �:3iR � ;t 1 a r`Y i.,. �.•="" iii c1 Y ara ,y c s Ir f � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J APPLICATION FOR 'APPROVAL-OF-PLANS FOR - - A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: V i: 2 I/--\ M D l 1 COU 1- n!'z:j2 . :N U CA V4 1-1 VAC 1 t j 12,5&1 2. Name of project: }gyp 55-(5 -Lot 3. Location TN:. ?WiM2So%J 4. Design Professional: �,►� . N Irk i'.. 5. Address: 2a $AjL.-r-DWM 90 D. 6. Drainage Basin: CK,9ToN N 10S 7. Tvne of Proiect: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted V 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... p 10. Has DEIS been completed and found acceptable by Lead Agency? ...............,g_ 11. Name of Lead Agency �4 114 -..- <::12..:Is.this project in an area under -the control of local planning,. zoning, or other officials, ordinances? - . 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge................. surface water -/, groundwater 16. If surface water discharge, what is the stream class designation? .................... h/1 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply. N /A Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ W0 21. Name of sewage system is 1A Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector�I<. 24. Project design flow (gallons per day) ................................. ............................... t) aD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.... D 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? iJ 0 28. Wetlands ID Number. ....................... .................. ..........................:.... 29. Is Wetlands. Permit required? ......................................:....... ............................... ---90 Has application been made to Town or Local DEC office? ............................... 9 JA 30. Does project require a DEC Stream Disturbance Permit? ... ..............................G 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............. ........ Yes/No ....... ice! 0, 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/NoQ DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... JA 6 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... �D 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 6 3 36. Tax Map ID Number ........................................................... Ma p Block Lot 37. Approved plans are to be returned to ..... Applicant_ Design Professional _ - NOTE: All applications for review and approval of a new SSTS'toaielocated within tl&.e NYC Watershed shall" -" b6 sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of Y impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.. SIGNATURES & OFFICIAL TITLES:. Mailing Address: ................................... 20 M 111.e:12 W t.,l 12D, 12, SO ITS 15 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Uj=0 LAMDp,-rj5 Located at t g$t V--j' T/V F,&-11 1�jR RS- J Tax Map # 4-+. Block -_5 Lot 3• Subdivision of V ITD LAM012°(1✓ Subdivision Lot # ! Filed Map # 25 11 Date Filed Gentlemen: This letter is to authorize t. Ag&j W , bj l C,4 LS a. 1P, ,r a duly licensed Professional Engineer ,— or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above-noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity .with the.provisions of Article 145 and/or 147 of the Education Law, the Public Health_. �Law,'and the "Puiiia " " itary Code. NIC Mailing Address OFE `� i i- � M State Wi Zip 1060 Telephone: -CA 14) Very truly yo s, Signed: (Owner of Property) Mailing Address: 11 oU L--T J(Z. A\l ; N A,: State M j Zip Telephone: (� 14) 8 qG - I!1,2 2 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH- - INDIVIDUAL WATER'SUPPLY &•SVBSMFACE`SEWAGE T12EAT�IE \fi SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT Cyr ''U %�/� � STREET LOCATION /�2 NAME OF OWNE REVIEWED BY R, AS, NIB, BH ATV TAX NIAP # Y N DOCUMENTS Y PERMIT APPLICATION ROSION CONTROL:HOUSE,WELL, SSDS PC -1 RC & DEEP HOLES LOCATED WELL PERMIT _ PWS LETTER PRESENTATIVE OF PRIMARY & EXPANSION LETTER OF AUTHORIZATION OCATION MAP DESIGN DATA SHEET (DDS) XP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE CORPORATE RESOLUTION F PUMPED, PIT & D BOX SHOWN & DETAILED SHORT EAF OUSE - NO.OF BEDROOMS PLANS - THREE SETS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. HOUSE PLANS - TWO SETS PROPERTY METES & BOUNDS VARIANCE REQUEST OUSE SETBACK NECESSARY (TIGHT LOT) FEE OUS SEWER -1/4" FT. 4 "0; TYPE PIPE SUBDIVISION NO NDS; MAX.BENDS 45° W /CLEANOUT LEGAL SUBDIVISION FILL SYSTEMS SUBDIVISION APPROVAL CHECKED C AY BARRIER PERC RATE - FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL REQUIRED DEPTH ILL SPECS FILL NOTES CURTAIN DRAIN REQUIRED FILL CERTIFICATION NOTE STANDPIPES DEPTH GAUGES GENERAL FILL PROFILE & DIMENSIONS OC NYC WATERSHED VOLUME ANS SUBMI D TO DEP PLL IN EXPANSION AREA ATED CHD TRENCH OVAL, IF REQ'D LF TRENCH PROVIDED 60 FT MAX. EEP TEST HOLES OBSERVED PARALLEL TO CONTOURS FRCS TO BE WITNESSED 100% EXPANSION PROVIDED - APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED _ . WETLANDS (TOWN/DEC PERMIT REQ'D ?) ... °: ON -PLLAN r.P'TiOiy�- SSTS•.. -- - .-_.•. TA ON DDS PLANS & PERMIT SAME 0' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL PRE 1969 NEIGHBOR NOTIFICATION ' TO FOUNDATION WALLS _15'WELL TO PL ETTER BI/ZBA 00' TO WELL, 200' IN DLOD, 150' PITS of 0 YR- FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) OTHER REQ'D PERMIT(S) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 0' TO WATER LINE (pits -20') SEWAGE SYSTEM PLAN - (NORTH ARROW) 0' INTERMITTENT DRAINAGE COURSE SDS HYDRAULIC PROFILE 200' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS RAVITY FLOW ONSTRUCTION NOTES 5'MIN to CDS= >50/olO'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <I% DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT 0' FROM FOUNDATION; 50' TO WELL F TING /GUTTER/CURTAIN.DRAINS WELL OIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM#,PEIRA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION ATUM REFERENCE CATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: NAM COUNTY DEPARTMENT OF HEALTH tv V ON OF ENVIRONMENTAL HEALTH SERVICES NSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERNUI 10 Located at Ill p Sjf 9r- -E`T Town or Village Subdivision name I-AM 0fg'(' Subd. Lot # Tax Map "! +.— Block J Lot Date Subdivision Approved q .-2 � A ) Renewal Revision Owner /Applicant Name 'q 1'['Q �,cj (� Date of Previous Approval Mailing Address 11 CG'U L"Te Ig M F t� L/\i U 0 & Zip 2] Amount of Fee Enclosed `i '3Ct�9 . G 0 Building Type K F51iJEN�irl� Lot Area 1.52 No. of Bedrooms Design Flow GPDCt? Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12E-Lo gallon septic tank and 4,54 Ag?S • Tr'- , Other Requirements: To be constructed by `rV tJ Address Water Supply: Public Supply From Address or: -q Private Supply Drilled by i j Address = I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date (a -25 License # 15i& 1. -21 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sevmge treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when c 'dered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. A oved for ' harge of domestic sanitary se a o /ply. p By: Title: l/C 1� Date: WWe copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A. WATER WELL - please print or type PCHD Permit # b ✓ Well Location: Street Address: TownNillage Tax Grid # Map Block 95 Lot(s)J. + Well Owner: Name: Address: v- Use of Well: )4 Residential Public Supply Air /Cond/Heat Pump Irrigation ,pprimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served 5 Z Est. of Daily Usage $40 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason S for Drilling Well Type ( Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes ," ( No Name of subdivision Lot No._ Water Well Contractor: :MX Address: ............... ............................... Is Public Water Supply available to site? .......... ....... Yes No Name of Public Water Supply: W/A TownNillage %A Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date::( -:° _ Applicant Signature: v PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless coxstruction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a war 11 driller certified by Putnam County. Date of Issue It.4114 i/ Permit IssuQ Official: Date of Expiration` C / Z.gI-/ %J Title: PIVI !1-L Peamit is loon White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ____ ___ ________ __ __ .•�- BATH .•..I 111 • it �f.1 J. • �- �.� r •• O BEDROOM 4 -JLJj_ y'•8" x 12"4'" � ORESSrNG• BEDROOM,. WALK* 13, -o- x 10" -0"' i - IN CLOSET • ..•�r T • t • ^tom. 1 - MASTER 8EOROOM BEDR00M2 j = OPEN N 17" -0 11' 0 15'•8• • - <: SECOND FLOOR 4828 = .-1344SF .. __ .-� _• .-• . - • • • ' .t— . 174: P TNAM ,COUNTX DEPARTMENT OF IcITC , E PLARJ APPROVED FOR jp' BED ODM COUNT O'U&hNINa pooh OINING HOOM 13,03112%0" ►-- • �rfit6 tar & Title IN -t ••-}; OPEN j ABOVE f LIVING ROOM FAMILY ROOM 12. 0.. s 1 •'.0.. 17' 0, ■ 1 7. o.. FOYER 1 FIRST FLOOR 4828 = 1'�4acF 14.11" (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C _ State EnvlraamentaLGuaAty •ReWeat- -- -- SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (O be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME. O O.SSS- 3., PROJECT LOCATION: Municipality County p(J 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 112 S'Ki r--I 5. IS PROPOSED ACTION: ® New ❑Expansion ❑ Mod! (Ica tionlalteration 6. DESCRIBE PROJECT BRIEFLY: QKO�. SS7S 7. AMOUNT OF LAND AFFECTED: i 532 Initially -532 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? QD Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? N Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: _.- .__.._... 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ❑ No If yes, list agency(s) and permitlapprovals EATTEIZ5,M OL-P&. 1�E>'T. — PJLfl6 • ��i2 11. DOES ANY ASPECT OP THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ® No If yes, list agency name and permll1approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor n e: Date: —5+ Signature: If the action Is In the Coastal Area, and you are a state agency, complete* the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by ,, gency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration ... maybe 'supersettLed'by -andther irnrolvea, *g y: —_. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced.by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other.effects not identified In C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. —0. 4S- THERE, --O LS TH€RE- LIKELY TO -BE, CONTROVERSY RELATED TO POTENTIAL ..A6VERSE�ENVIRONMEN7AL :IMPACTS?; _ ❑ Yes ❑ No if Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by.Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EA4F and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency TitFe--oFResponsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date 2 DEPARTMENT OF HEALTH Division of Environmental Health Services .4 Geneva Road Brewster, . New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 July 10, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Lamorte Fair Street, Lot #4 (T) Patterson Reservoir Basin Middle Branch Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on July 7, 1998 is complete. The Department will notify you by July 30, 1998 of its determination. The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. U Joint review .with- the_NYCDEP will _commence pursuant to the guidelines set fort h —, _ -- - in the Watershed Agreement. '- _... -... _...�_...__..__ . -- If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. V ruly yours, Robert Morris. PE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner I_A14 Jr[ TC— Address FAIR ST, Located at (Street) Tax Map fy Block 3 Lot 3, (indicate nearest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre-soaking 7Z16z9v— Date of Percolation Test -?J=) 7Z Z13 Hole No. Run No. Time Start - Stop ElaNe Time 11, n.) Nth to Water From Ground Surface (Inches) Start Stop Water Level Drop es Indies Percolation Rate Min/Inch _ES 2 3 4 5 2 /0" 4 21 17 3 5yie Z Nit I 4 ti 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are oDtainea at eacn percolation test hole. (i.e. s I min for 1-30 min/inch, --q 2 min for 31-60 min/inch) All data to'be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 Page 2 98004 -4 We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Vey truly yours, LAURENT ENGINEERING ASSOCIATES; P.C. Harry W. ichols, Jr., P.E. HWN: M:bd 98004 -4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES k ,.DESIGN.DATA =SHEET - SUBSURFACE SEWAGE TREATMENT "SYSTEM Owner V 1 To L,b �D IZ'i'X% Address cao L-ra2 AV .T ?A-Wi t„ TG Located at (Street) I% j R E Q�atT Tax Map Block -45 Lot 3A!± (indicate nearest cross street) Municipality j�,q- �-[��SD Drainage Basin )01__* _it SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 7�7 - 1:3 -�__ Hole No. Run No. Time Start -Stop Ela se Time Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate N En/Inch i 1 '.3 - 10'.00 22 2 3. :24— 1. 2 10.01 10'2 2 1l -Z I 3 10,10- '.o i 2 23 4 5 2 1 61* 41 - I o'. 3o 253/ 2.. _ 2_ 1.. o._^ 30 2 3 4 4 5 1 2 3 .4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootainea at earn percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for. review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered %%ole observations made by: Date? l Y� �Et� , � khi +T.l; Design Professional Name: gA_I�1, N I G� -�olrs �R•T . Address: 20 M j t_ta0 W N gj2, JT So rrj_ 1g_ .,� gnn4q -1/0 Design Professional's Seal VA•idi HOO�i�I" LU �� AM Z� I���fFSS1��°�i % DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _. DEPTH ..... ...4 r .._..._rw r. ... . HOLE NO. _ «. .. .0 _., .. —. .._ ... . p .. HOLE NO. M - . �, _t•i'c_ v.n... ,.c «v Ve- -iar_z 1ss.. �. _ HOLE NO. G.L. 0.5' '1.01 • . 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4:5' 5.0' 5 5', fi 6.01: ... 7 7.5' 8.0' 8.5' 10.0' }.ry _ �.tR�r•, r C• X• sue,. .�! . Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered %%ole observations made by: Date? l Y� �Et� , � khi +T.l; Design Professional Name: gA_I�1, N I G� -�olrs �R•T . Address: 20 M j t_ta0 W N gj2, JT So rrj_ 1g_ .,� gnn4q -1/0 Design Professional's Seal VA•idi HOO�i�I" LU �� AM Z� I���fFSS1��°�i % LAURENT ENGINEERING ASSOCIATES, P.C. LLBROPKE OFF JCE.GENTRE .. ; i " \ Route 22 & Milltown Road Brewster, New York 10509 (91.4)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. \ CONSULTING SITE ENGINEERS June 30, 1998 Robert Morris, P.E. Putnam County Health Department. 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Lot 4 _ LaMorte Subdivision Fair Street Patterson, N.Y. Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS -4 "Proposed SS,DS ", dated 6/25/98. 2. ' "Short EAF ", dated 6/25/98. - 3. "Application For Approval of Plans For a Wastewater Disposal System ". - 4. "Construction Permit for Sewage Dis osal S stem" dated 6/25/98: T i 5. "Application to Construct a Water Well ", dated 6/25/98. , 6. "Design Data Sheet ". - T. "Letter of Authorization ", dated 6/25M. . 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 9.- Review Fee in the amount of $300.00. It appears that this project will fall under joint review inthat the project is within 200 feet of a stream. We will contact Gene Reed to schedule witnessing of the percolation tests. REVISIONS PUTNAM ENGINEERING, PL-C. DATE ENGINEERS - ARCHITECTS 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 (845) .279 -6789 PAX (845) 279 -6769 7 ' "k W., I - PutnaM Cournty Departm- efit of Health -Division Of kkvironmental Health Servioss Approve noted for conformance with applim Rule I t nd Regulations of the Co I Health Departme*-/ Signature & Title PREPARED FOR: i KUY f KING ANAKK BUILDERS FAIR*. STREET MPT; Y I OF j P1 NEIY -" 1 " 1Xpol* JANUARY 2001 ORM T MANAGER GAT IT By BY PML AS NOTED C AS-E S.S.1 TAX MAP 44 4.